Depression Treatment: Design and Analysis of Non-Pharmacological Treatment Trials With Multiple Therapists Per Patient.

Published August 7, 2012

Design and analysis of non-pharmacological treatment trials with multiple therapists per patient.

Stat Med. 2012 Aug 2;
Roberts C, Walwyn R

In trials of physical and talking therapies, nesting of patients within therapists has statistical implications analogous to those of cluster randomised trials. Nevertheless, the clustering effect may be more complex, as it interacts with treatment. For some therapies, individual patients may receive care from multiple therapists of the same type, so that patients are no longer strictly nested within therapists, creating a ‘multiple-membership’ relationship between patients and therapists. This paper considers methods of analysis and sample size estimation for trials with multiple-membership clustering effects. It is motivated by a trial of a psychotherapy for the treatment of adolescent depression with cognitive behavioural therapy. We tested methods and issues in a Monte Carlo simulation study, simulating trials with multiple membership. Results demonstrate satisfactory performance in terms of convergence and give estimates of the intra-cluster correlation coefficient and empirical test size similar to a simple hierarchical?design. We derive formulae for sample size and power for multiple-membership trial designs. We then compare estimates of power from this formula with empirical power derived from the simulation study. Finally, we show that we can easily extend formulae for sample size and power to allow consideration of power and sample size for certain types of more complex interventions. These include situations where therapists of different types deliver separate components of the intervention, creating a cross-classified relationship, or where several therapists deliver a group-administered treatment, creating further levels. Copyright © 2012 John Wiley & Sons, Ltd.
HubMed – depression

The Influence of the Internalization of Emotional Regulation on Mental Health Among the Taiwanese People: The Moderating Effect of Cultural Fit.

Filed under: Depression Treatment

Asia Pac J Public Health. 2012 Aug 2;
Chu LC

This study used a 2-stage questionnaire survey to explore whether self-regulation by withholding negative emotions (SRWNE) affects mental health and examines further whether cultural fit can moderate the relationship between SRWNE and mental health. The 2-stage studies used data collected from 405 (time 1) and 313 (time 2) full-time staff employed by private and public enterprises in Taiwan. The author tested hypotheses through the use of hierarchical multiple regression. The results showed that controlled SRWNE through external regulation and introjected regulation is significantly associated positively with somatic symptoms, anxiety and insomnia, social dysfunction, and severe depression, whereas autonomous SRWNE through identified regulation is significantly associated negatively with anxiety and insomnia, and social dysfunction. In addition, this study also found that cultural fit may moderate the relationship between SRWNE or introjected regulation and identified regulation and the mental health indicators.
HubMed – depression

Waiting for thyroid surgery: A study of psychological morbidity and determinants of health associated with long wait times for thyroid surgery.

Filed under: Depression Treatment

Laryngoscope. 2012 Aug 2;
Eskander A, Devins GM, Freeman J, Wei AC, Rotstein L, Chauhan N, Sawka AM, Brown D, Irish J, Gilbert R, Gullane P, Higgins K, Enepekides D, Goldstein D

OBJECTIVES: Patients with thyroid pathology tend have longer surgical wait times. Uncertainty during this wait can have negative psychologically impact. This study aims to determine the degree of psychological morbidity in patients waiting for thyroid surgery. STUDY DESIGN: Prospectively assessing patients pre- and postoperative psychological morbidity (level 2c). METHODS: Patients waiting for thyroidectomy were mailed a sociodemographic and four psychological morbidity questionnaires: Impact of Events Scale-Revised (IES-R), Illness Intrusiveness Ratings Scale (IIRS), Perceived Stress Scale (PSS) and Hospital Anxiety and Depression Scale (HADS). We assessed whether anxiety was related to length of wait and a number of clinical/sociodemographic factors. RESULTS: We achieved a 53% response rate over a 3-year period, with 176 patients providing complete preoperative data; and 74 (42%) completed postoperative data. The average age was 53 (±12) years; 82% were female. Respondents with a suspicious or known malignancy waited an average of 107 days while those with benign neoplastic biopsies waited an average of 218 days for thyroidectomy. Respondents reported substantial psychological morbidity with high IES-R, IIRS, PSS, and HADS scores. There was no significant association between psychological morbidity and wait times, clinical or sociodemographic factors. Postoperative anxiety decreased significantly in all psychological morbidity measures except for the IIRS. CONCLUSIONS: Patients waiting for thyroid surgery have mild to moderate psychological morbidity and long wait times for surgery. These appear not to be related. Psychological morbidity decreases after surgery. Reducing wait time can potentially reduce the time that patients have to live with unnecessary stress and anxiety. Laryngoscope, 2012.
HubMed – depression

Jesse Jackson Jr. 'debilitated' by depression but no plans to step down …

Filed under: Depression Treatment

… by depression but Jackson's father says the Illinois congressman has no plans to quit his post. The Rev. Jesse Jackson said he has visited his son at the Mayo Clinic in Rochester, Minn., where he is being treated. He said there's no timeline for …
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